Hormone Replacement Therapy Associated With Meibomian Gland Dysfunction

Doctor talking with a young woman that expects a baby at the clinic waiting room
Mature female doctor talking with a pregnant young woman and explaining her a medical procedure.
The study also shows decreased risk of meibomian gland pathology during pregnancy.

This article is part of Ophthalmology Advisor’s conference coverage from the 2021 Fall Scientific Symposium of the American Society of Ophthalmic Plastic and Reconstructive Surgery, held in New Orleans from November 11 to 12, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the oculoplastic researchers and other clinicians at the ASOPRS. Check back for more from the ASOPRS 2021 Fall Scientific Symposium.

Hormone replacement therapy (HRT) is associated with increased risk of diagnosis of meibomian gland dysfunction (MGD), except for in the case of pregnancy, researchers found in a report presented at the American Society of Ophthalmic Plastic and Reconstructive Surgery 52nd Annual Fall Scientific Symposium in New Orleans, November 11-12.

Prior studies have suggested these hyperestrogenic states are linked with dry eye syndrome (DES) but not chalazia or MGD. Here, researchers reviewed whether periods of higher estrogen levels incur risk of  any of these conditions.

Researchers analyzed medical records of 495,051 patients who had visited a particular tertiary care center in the US in 2019 or 2020. Individuals diagnosed with Sicca syndrome were excluded from the study. 

After adjusting for age and race, the researchers discovered that patients during pregnancy (n=32,541) were less likely to be diagnosed with MGD (P <.0001), chalazion (P =.002), and DES (P <.0001). Patients undergoing HRT (n=2010) had increased odds of developing DES (P <.0001) and MGD (P <.0001). Those undergoing IVF (n=1242) did not have increased risk of chalazion, DES or MGD.

“[This is the] first reported positive association of HRT with MGD,” the investigators said.

Previous studies have indicated pregnancy is linked with DES signs and symptoms, the researchers reported. They said that their finding evidence suggesting the opposite is true could be caused by behavioral factors outside of the analysis, such as pregnant patients delaying ophthalmology appointments. They said the lack of association between IVF and any of the 3 ocular diagnoses might be a direct effect of medications or rapid increase in estrogen levels. 

Visit Ophthalmology Advisor’s conference section for complete coverage of the ASOPRS 2021 Fall Scientific Symposium.



Liu T, Ying G-S, Mehta S. Retrospective study of association between hyper-estrogenic states and diagnosis of chalazia, dry eye syndrome, and meibomian gland dysfunction. Poster presented at ASOPRS 52nd Annual Fall Scientific Symposium; November 11-12, 2021; New Orleans, LA.